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Manager Of Utilization Management Jobs in Rio Rancho, NM

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Manager Of Utilization Management information

See Rio Rancho, NM salary details

$36.7K

$85.6K

$157.6K

How much do manager of utilization management jobs pay per year?

As of Jul 8, 2026, the average yearly pay for manager of utilization management in Rio Rancho, NM is $85,606.00, according to ZipRecruiter salary data. Most workers in this role earn between $56,000.00 and $103,000.00 per year, depending on experience, location, and employer.

What is the difference between Manager Of Utilization Management vs Utilization Review Nurse?

AspectManager Of Utilization ManagementUtilization Review Nurse
CredentialsRN, sometimes with management certificationsRN, with clinical experience
Work EnvironmentAdministrative, overseeing teams and policiesClinical, performing reviews and assessments
Employer & IndustryHospitals, insurance companies, healthcare organizationsHospitals, insurance companies, healthcare providers
Primary FocusManaging utilization review processes and team supervisionConducting individual patient reviews and assessments

The main difference is that the Manager Of Utilization Management oversees the entire utilization review process and team management, while the Utilization Review Nurse focuses on performing clinical reviews of patient cases. Both roles require RN credentials and work within healthcare or insurance settings, but their responsibilities and focus areas differ significantly.

What does a utilization manager do?

A utilization manager oversees the review and authorization of healthcare services to ensure they are medically necessary and appropriate. They analyze patient records, coordinate with healthcare providers, and use utilization review tools to manage costs and quality of care within healthcare organizations.

What degree do you need for utilization management?

A manager of utilization management typically needs at least a bachelor's degree in healthcare, nursing, health administration, or a related field. Many employers prefer candidates with a master's degree or relevant certifications such as the Certified Professional in Healthcare Quality (CPHQ) or Certified Case Manager (CCM). Strong knowledge of healthcare policies, insurance processes, and data analysis skills are also important for the role.

What is the highest paying manager position?

The highest paying manager positions often include executive roles such as Chief Operating Officer (COO), Chief Executive Officer (CEO), or Vice President, which typically offer salaries significantly higher than other management roles. In healthcare, senior management roles like Director of Utilization Management or Medical Director can also command high compensation, especially with relevant certifications and extensive experience.

What is the highest paying job in healthcare management?

In healthcare management, the highest paying roles are often executive positions such as Chief Executive Officer (CEO) or Chief Operating Officer (COO), with salaries exceeding $150,000 annually. Other high-paying roles include hospital administrators and healthcare system directors, especially those overseeing large organizations or specialized departments, often requiring advanced degrees and extensive experience.
What cities near Rio Rancho, NM are hiring for Manager Of Utilization Management jobs? Cities near Rio Rancho, NM with the most Manager Of Utilization Management job openings:
Manager Of Utilization Management jobs near you
(RN)Auditor, Healthcare Services - NCQA

(RN)Auditor, Healthcare Services - NCQA

Molina Healthcare

Albuquerque, NM • On-site

$29.05 - $56.64/hr

Full-time

Re-posted 8 days ago

Molina Healthcare rating

8.1

Company rating: 8.1 out of 10

Based on 193 frontline employees who took The Breakroom Quiz

135th of 278 rated insurance

Job description

JOB DESCRIPTION 

Job Summary

Provides support for healthcare services clinical auditing activities. Performs audits for clinical functional areas in alignment with regulatory requirements - ensuring quality compliance and desired member outcomes. Contributes to overarching strategy to provide quality and cost-effective member care. This role supports the New Mexico Turquoise Care Contract. 
 

Essential Job Duties

Performs audits in utilization management, care management, member assessment, behavioral health, and/or other clinical teams, and monitors clinical staff for compliance with National Committee for Quality Assurance, Centers for Medicare and Medicaid Services (CMS), and state/federal guidelines and requirements. May also perform non-clinical system and process audits as needed. 
Audits for clinical gaps in care from a medical and/or behavioral health perspective to ensure member needs are being met. 
Assesses clinical staff regarding appropriate clinical decision-making. 
Reports monthly outcomes, identifies areas of re-training for staff, and communicates findings to leadership. 
Ensures auditing approaches follow a Molina standard in approach and tool use. 
Maintains member/provider confidentiality in compliance with the Health Insurance Portability and Accountability Act (HIPAA), and professionalism in all communications. 
Adheres to departmental standards, policies and protocols. 
Maintains detailed records of auditing results. 
Assists healthcare services training team with developing training materials or job aids as needed to address findings in audit results. 
Meets minimum production standards related to clinical auditing. 
May conduct staff trainings as needed.  Communicates with quality and/or healthcare services leadership regarding issues identified, and works collaboratively to subsequently resolve/correct. 
 

Required Qualifications

At least 2 years health care experience, with at least 1 year experience in utilization management, care management, and/or managed care, or equivalent combination of relevant education and experience. 
Registered Nurse (RN). License must be active and restricted in state of practice. 
Strong attention to detail and organizational skills. 
Strong analytical and problem-solving skills. 
Ability to work in a cross-functional, professional environment. 
Ability to work on a team and independently. 
Excellent verbal and written communication skills. 
Microsoft Office suite/applicable software program(s) proficiency. 
 

Preferred Qualifications

Prior experience in clinical review/auditing of care management.

Familiarity with the New Mexico Turquoise Care Contract, NCQA (National Committee for Quality Assurance) auditing and performance standards or  IPRO. 

Analytical ability to review data and determine quality trends. 
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $29.05 - $56.64 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Employment Type: Full Time

What Molina Healthcare employees say

Pay

Benefits

Hours and flexibility

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About Molina Healthcare

Sourced by ZipRecruiter

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

Long Beach, CA, US

Year founded

1980

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